Airway Obstruction Immediately after Endotracheal Intubation for Removal of Cervico-Mediastinal Cystic Hygroma: A case report / 대한마취과학회지

Abrupt increase in the size of cervico-mediastinal tumor due to infection or spontaneous hemorrhage into cyst can induce severe tracheal compression and therefore sudden death. A 5 year old boy, who had a history of URI, had an enlarging cystic hygroma on the right side of the neck and anterior mediastinum. Under diagnosis of the cervico-mediastinal cystic hygroma, surgical removal was scheduled. After induction of anesthesia, intubation was done without any difficulty. A few minutes later, signs of partial airway obstruction were appeared. And within a very short period, total airway occlusion occurred. The tracheal tube was removed and manual ventilation was performed with positive airway pressure, but ineffective. We attempted to puncture cricothyroid membrane with 14 Gauge needle in order to ventilate manually. As soon as we puncture cricothyroid membrane, straw-colored fluid, not air, gushed out through a needle. After aspiration of about 200ml of cystic fluid, the obstructive signs disappeared and the patency of the airway was maintained. Intraoperatively, no more airway problems occured and vital signs were stable. And postoperatively, patient had no specific complications and discharged on the 7th day after operation.

The Level of Tuffier's Line in Korean Adults / 대한마취과학회지

BACKGROUND: Tuffier's line, which connect the two iliac crests, is the often used landmark in determining the level for the needle insertion into lumbar intervertebral space for the spinal and/or epidural blocks. However, the level of Tuffier's line varies depending on the observer. METHODS: Two methods were used to measure the level of Tuffier's line was measured on a simple abdominal X-ray taken in the supine position (study 1). Second, the level of Tuffier's line was also measured on fluroscopy of students in the sitting position (study 2). RESULTS: Overall, the level of Tuffier's line was most frequently observed along the L4-5 intervertebral space and second most frequently observed along the lower one-third of L4. In study 1 using abdominal X-ray, the level of Tuffiers line was most frequently observed along the L4-5 intervertebral space, however, the second most frequently observed level varied depending on the ages of the volunteers. In study 2 using fluoroscopy, the level of Tuffier's line was most frequently observed along the L4-5 intervertebral space and second most frequently observed along the upper one-third of L5. CONCLUSIONS: The level of Tuffier's line was most frequently observed along the L4-5 intervertebral space both in the supine and sitting positions. Further, the level of Tuffier's line went higher with age for women but stayed constant independent of age for men in the supine position.